Journal Watch - 2014

Home HD in people over age 65

As MEI has noted in our MATCH-D tool, age alone should not be a contraindication for home PD or HD—and a new study shows this. In an international, multi-center study of 79 people over age 65 at dialysis initiation, event-free survival on home HD was 85% at 1 year, 77% at 2 years, and 24% at 5 years, with technique survival of 92%, 83%, and 56%, respectively. Just over half (54%) needed a helper for home HD.

Men on PD fare worse with high serum uric acid levels

In a study of 985 people using PD in China followed for more than 2 years, men in the highest tertile for serum uric acid were at the highest risk of death. The results were adjusted for age; BMI; comorbidities; residual kidney function; total Kt/V; use of allopurinol, ACE-inhibitors and ARBs; Hgb, serum albumin, creatinine, calcium and phosphorus, triglycerides, LDL cholesterol, and high-sensitivity C-reactive protein.

Tolvaptan may boost urine output for people on PD

A drug called tolvaptan nearly doubled the average urine volume and reduced the need for PD fluid volume by about 5000 mL weekly in a small trial of 11 people. The medication did not affect Kt/V, serum sodium, or serum albumin.

Home HD is cost-effective vs. in-center

A review of six studies of dialysis costs between 2000 and 2014 found that contemporary home HD options (short daily HD and nocturnal HD) may have higher short-term costs, but offer long-term cost savings compared to in-center HD, due to lower staff costs and better health outcomes.

HD recovery time predicts survival (DOPPS)

In a finding with important implications for longer and/or more frequent HD, 6,040 in-center HD patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were asked “How long does it take you to recover from a dialysis session.” The shorter the recovery time, the lower the risk of hospitalization and death.

Ferritin levels may predict residual renal function (RRF) drop on PD

Besides being an iron storage protein, ferritin is also a marker of inflammation. In a new study from Korea, the ferritin levels and RRF were measured in 123 people on PD. Those whose ferritin levels were high (>250 ng/mL) had significantly greater loss of RRF than those with lower ferritin levels. Multiple linear regression pointed to ferritin levels as an independent risk factor.

Fine-tuning fluids with bioimpedance may save lives on PD

A study of 529 PD patients tracked between 2008 and 2012 using a Body Composition Monitor found that overhydration (OH) is lethal. Patients in the top 33% for OH had an 83% higher risk of death. Body mass index (BMI) was not a factor.

For older patients, PD offers quality of life boost

Compared to younger people, those over age 65 on PD reported better quality of life, even after adjustment for case mix and comorbidities. Levels of anxiety and depression were about the same between older and younger patients. Those who used a cycler for PD reported fewer symptoms. The authors conclude that “Patients across different age groups should be given non-biased information about both peritoneal dialysis modalities and individual preferences should be elicited and carefully considered by healthcare providers.”

Should PD catheters be fixed in place?

PD catheters that migrate may need to be moved or replaced. In a new study from Japan, 16 patients had the usual PD catheter placement, and 25 had their catheters placed using a fixation technique. The fixed catheters were far more likely to be in the right position, and less likely to move out of position. Complication rates were similar for both groups.